The power of psychedelics meets the power of placebo: ketamine, opioids, and hope in depression treatment | Boris Heifets & Theresa Lii
Nov 21, 2024
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Join Boris Heifets, a Stanford anesthesiologist researching psychedelic medicine, and Theresa Lii, his collaborator in exploring ketamine and the placebo effect. They dive into the surprising dynamics of ketamine in depression treatment. Discover how much of its efficacy stems from the drug versus the excitement of trial participation. They also discuss the complex interplay between the placebo effect and the opioid system, while challenging conventional views on placebo in psychiatric care, revealing its potential as a valuable aspect of treatment.
The podcast reveals that the interplay between ketamine and placebo effects challenges conventional views on treatment efficacy in mental health care.
Innovative research methods distinguish genuine drug effects from placebo responses, shedding light on the complexities of depression treatment.
Deep dives
The Promise of Psychedelic Medicine
The podcast discusses the potential of psychedelics like psilocybin and ketamine to treat mental health disorders such as depression and PTSD. These substances are gaining attention due to their rapid onset of effects, which can occur within hours, contrasting sharply with traditional antidepressants that often take weeks to work. Research over the past 25 years has indicated that ketamine can lead to sustained improvement in depressive symptoms after just one dose. This changing perspective on mental health treatment signifies a potential shift away from conventional therapies and highlights the need for continued exploration of psychedelic substances in clinical settings.
Decoding the Placebo Effect
A key aspect of the conversation centers around the placebo effect and its implications for interpreting clinical trials involving psychedelics. The unique challenge with these trials is that participants often have preconceived notions influenced by the cultural context surrounding psychedelics, which can blur the lines between genuine drug effects and placebo responses. Yet, the discussion underscores the valuable role of expectation and belief in healing, particularly in mental health. Understanding how these psychological factors interact with drug effects is essential for more accurately assessing treatment outcomes.
Innovative Research Approaches
The researchers introduced a method of studying the antidepressant effects of ketamine during surgical anesthesia, which effectively eliminated consciousness and thus the influence of expectation. This innovative approach allows for a clearer distinction between the actual pharmacological effects of ketamine and any potential placebo responses. Surprisingly, results showed that both the ketamine and placebo groups experienced significant reductions in depressive symptoms, raising important questions about the underlying mechanisms of these treatments. This experiment opens the door for further inquiries into how clinical settings and the nature of patient experience can shape treatment outcomes.
The Interplay of Opioids and Placebo Sensitivity
A new analysis from the research suggests that ketamine may have the potential to reset an individual's sensitivity to placebo effects, particularly in those who have chronic exposure to opioids. The findings indicate that while participants receiving ketamine maintained strong antidepressant benefits, those relying on placebo alone exhibited reduced therapeutic effects if they had a history of opioid use. This suggests that ketamine might help individuals regain some of their responsiveness to placebo by potentially resensitizing their endogenous opioid system. These insights challenge traditional views on treatment efficacy and highlight the complex interplay between pharmacological and psychological elements in healthcare.
Join us as we dive back into the world of psychedelic medicine with anesthesiologists Boris Heifets and Theresa Lii, who share intriguing new data that sheds light on how ketamine and placebo effects may interact in treating depression.
We explore provocative questions like: How much of ketamine's antidepressant effect comes from the drug itself versus the excitement of being in a psychedelics trial? What do we know about how placebo actually works in the brain? And should we view the placebo effect as a feature rather than a bug in psychiatric treatment?
Join us as we examine the complex interplay between psychoactive drugs, the brain's own opioid system, and the healing power of hope in mental health care.
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Episode Credits
This episode was produced by Michael Osborne at 14th Street Studios, with production assistance by Morgan Honaker. Our logo is by Aimee Garza. The show is host
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